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Test 3 Flashcards

1
Q

Humalog (lispro)

A
  • Rapid acting analog
  • Insulin
  • Onset: 10-30 minutes
  • Peak: 30-90 minutes
  • Duration: 3-6 hour
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2
Q

Novolog (aspart)

A
  • Rapid acting analog
  • Insulin
  • Onset: 10-30 minutes
  • Peak: 30-90 minutes
  • Duration: 3-6 hour
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3
Q

Fiasp

A
  • Rapid acting analog
  • Insulin
  • Onset: 10-30 minutes
  • Peak: 30-90 minutes
  • Duration: 3-6 hour
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4
Q

Glulisine (apidra)

A
  • Rapid acting analog
  • Insulin
  • Onset: 10-30 minutes
  • Peak: 30-90 minutes
  • Duration: 3-6 hour
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5
Q

Human regular insulin

U-100 & U-500

A
  • Short acting insulin
  • Onset: 30-60 minutes
  • Peak: 2-5 hours
  • Duration: 5-8 hours
  • Fewer and fewer providers are prescribing it due to its delayed onset
  • Must inject before eating and wait to eat until the onset
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6
Q

Human NPH

A
  • Intermediate acting insulin
  • Cloudy insulin
  • Onset: 2-4 hours
  • Peak: 4-12 hours
  • Duration: 12-18 hours
  • Always draw after regular insulin
  • Used less and less due to delayed onset
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7
Q

Glargine (Lantus)

A
  • Long acting analog
  • Insulin
  • Onset: 1-2 hours
  • Peak: Peakless
  • Duration: 20-24 hours
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8
Q

Detemir (Levemir)

A
  • Long acting analog
  • Insulin
  • Onset: 1-2 hours
  • Peak: 6-14 hours
  • Duration: Up to 24 hours
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9
Q

Degludec (Tresiba)

U-100 & U-200

A
  • Ultra long acting insulin
  • Onset: 30-90 minutes
  • Peak: No peak
  • Duration: >24 hours (42 hours)
  • Can be injected at any time of day
  • Can be mixed with other insulins (unlike most long-acting insulins)
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10
Q

U300 Glargine (Toujeo/Sanofi)

A
  • Ultra long acting insulin
  • Smaller depot surface area means reduced rate of absoprtion and less discomfort when injecting
  • 23 hour half life (steady state in 4 days)
  • Duration: <36 hours
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11
Q

Afrezza

A
  • Inhaled insulin
  • Onset: 12 minutes
  • Peak: 35-45 minutes
  • Duration: 15.-3 hours
  • Only offered in 4, 8, and 12 unit doses, making it difficult to titrate
  • Risk for bronchospasm (spirometry required prior to prescribing)
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12
Q

Metformin (Glucophage/Riomet)

A
  • Biguanide
  • MOA Primary: Decrease glucose production in the liver via suppression of gluconeogenesis
  • MOA Secondary: Enhanced glucose uptake and utilization in peripheral skeletal muscle
  • Indications: 1st choice for obese patients, prevention of T2DM
  • Advantages: No risk of hypoglycemia in monotherapy, weight loss, can be used in combo with insulin sensitizing drugs, can be used in kids
  • Adverse effects: Abdominal cramping, nausea, decrease absorption of B12 and folic acid
  • Contraindicated in patients with renal insufficiency (GFR <30ml/min)
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13
Q

Glipizide (Glucatrol), glimeperide (amaryo), and glyburide (diabea/micronase)

A
  • Insulin secretagogue
  • Sulfonylurea
  • MOA: Stimulates insulin secretion from pancreatic b cells
  • 1st line of treatment for T2DM
  • Given oral QD or BID with meals
  • Adverse effects: Hypoglycemia, weight gain, GI disturbances
  • Contraindicated in T1DM, pregnancy, and sever liver/kidney disease
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14
Q

Repaglinide (Prandin)

A
  • Insulin secretagogue
  • Meglitinide
  • MOA: Stimulates insulin secretion from pancreatic b cells (different site than sulfonylureas)
  • Nursing considerations: Always give with a meal, peak effect in 1 hour
  • Adverse effects: Hypoglycemia, possible weight gain
  • Contraindications: T1DM, pregnancy, liver disease
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15
Q

Nateglinide (Starlix)

A
  • Insulin secretagogue
  • Meglitinide
  • MOA: Stimulates insulin secretion from pancreatic b cells (different site than sulfonylureas)
  • Nursing considerations: Always give with a meal, peak effect in 1 hour
  • Adverse effects: Hypoglycemia, possible weight gain
  • Contraindications: T1DM, pregnancy, liver disease
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16
Q

Rosigliazone (Avandia)

A
  • Thiazolidinedione (TZD)
  • MOA: Binds to nuclear receptor PPARy, a receptor that regulates the transcription of a gene involved in glucose producion, transport, and utilization
  • Net effect: Cellular response to insulin is increased, improved insulin sensitivity in skeletal muscle (and adipose tissue and the liver), and reduced hepatic glucose production
  • Adverse effects: Fluid retention (can lead to edema and HF), increased risk of fracture in women, hypoglycemia (when used with insulin), possible ovulation, increased risk of bladder cancer)
  • Contraindications: Severe liver disease, DKA, T1DM, pregnancy, HF (block box warning)
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17
Q

Pioglitazone (Actos)

A
  • Thiazolidinedione (TZD)
  • MOA: Binds to nuclear receptor PPARy, a receptor that regulates the transcription of a gene involved in glucose producion, transport, and utilization
  • Net effect: Cellular response to insulin is increased, improved insulin sensitivity in skeletal muscle (and adipose tissue and the liver), and reduced hepatic glucose production
  • Adverse effects: Fluid retention (can lead to edema and HF), increased risk of fracture in women, hypoglycemia (when used with insulin), possible ovulation, increased risk of bladder cancer)
  • Contraindications: Severe liver disease, DKA, T1DM, pregnancy, HF (block box warning)
18
Q

Acarbose (Precose) and migliitol (glyset)

A
  • Alpha-glucosidase inhibitor
  • MOA: Inhibits intestinal alpha-glucosidase enzymes, slowing down intestinal digestion and absorption of carbohydrates
  • Adverse effects: Flatulence, cramps, distension, and diarrhea
  • Contraindications: Inflammatory bowel disease, colonic ulceration, partial intestinal obstruction
19
Q

Pramlintide (Symlin)

A
  • Amylin mimetic
  • Synthetic analog of human amylin
  • Supplement to mealtime insulin for T1DM and T2DM
  • MOA: Delays gastric emptying and suppresses glucagon secretion, allowing for increased feeling of fullness. Increased fullness = eat less
  • Only a small reduction in A1C and weight
  • SubQ injection
  • Adverse effects: Risk for severe hypoglycemia (Pre-prandial insulin dose may need lowering)
20
Q

Exenatide

A
  • Incretin therapy
  • GLP-1 Receptor Analog
  • MOA: Binds to GLP-1 receptor on beta cells, which enhances glucose-dependent insulin secretion and suppresses glucagon levels
  • SubQ BID injection (before or within 1-h of meals)
  • Monotherapy for T2DM or adjunct to metformin and/or sulfonylurea
  • Reduces the risk of stroke and heart attack in adults with T2DM and heart disease
  • Adverse effects: Mild GI, risk for hypoglycemia when given with sulfonylureas or insulin,
21
Q

Sitagliptin (Januvia), saxagliptin (Onglyza)

A
  • Incretin therapy
  • DPP-4 inhibitors
  • MOA: Inhibits DPP4, and enzyme responsible for breaking down proteins that stimulate insulin producing cells after a meal, resulting in increased glucose dependent insulin secretion and decreased glucagon secretion
  • Use: Monotherapy or in combo with other agents
  • Less effective than GLP-1 agonists
  • Administration: PO once per day without regard to food
  • Adverse effects: Upper respiratory infection, headache, GI symptoms, angioedema (rare)
22
Q

Canagliflozin (Invokana), empagliflozin, dapagliflozin

A

-SGLT-2 inhibitor
-MOA: Inhibits SGLT2 in proximal nephron, resulting in decreased glucose reabsorption in the kidney (block 50-80 grams of glucose per day)
-Cardiovascular effects: Decreased weight, BP, and CVD events
Adverse effects: Genitourinary infections, UTI, dehydration-orthostasis (caution when used in combo with diuretics)

23
Q

Levothyroxine (Synthroid)

A
  • Synthetic preparation of thyroxine (T4)
  • Drug of choice for hypothyroidism
  • 7 day half life
  • Taken PO in the morning 30-60 minutes before eating with water
  • Adverse effects: Excessive amounts can result in hyperthyroidism (tachycardia, angina, tremors), and can intensify the effects of warfarin
  • Doses must be titrated slowly
  • Interactions: Food, warfarin, catecholamines (increased cardiac responsiveness)
24
Q

Methimazole

A
  • Thionamide, anti-thyroid drug
  • First line drug for hyperthyroidism
  • MOA: Reduces synthesis of T3 and T4
  • Used primarily for Grave’s disease
  • Adjunct to radiation
25
Q

Propythiouracil (PTU)

A
  • Thionamid, anti-thyroid drug

- MOA: Reduces the synthesis of T3 and T4

26
Q

Radioactive iodine

A
  • Thyroid tissue destroyer

- Used in Grave’s disease and thyroid cancer

27
Q

Celecoxib

A
  • 2nd gen NSAID

- Rheumatoid arthritis treatment

28
Q

-Prednisone and Prednisolone

A
  • Glucocorticoids
  • Rheumatoid arthritis treatment
  • Used when NSAIDs are unable to control symptoms
  • General symptoms: Oral
  • Specific joints: Intra-articular injection
  • Adverse effects: Osteoporosis, adrenal suppression, GI ulceration, hyperglycemia
29
Q

Methotrexate (Rheumatrex, Trexall)

A
  • Non-biologic disease-modifying antirheumatic drug (DMARD)
  • 1st line drug fir RA
  • MOA: Immunosuppression of B and T lymphocytes
  • Results in 3-6 weeks
  • Route: IM, SC, PO
  • Nursing consideration: Require liver, kidney, and CBC tests. Must give folic acid supplements (decreases GI and hepatic toxicity)
  • Adverse effects: Hepatic fibrosis, bone marrow suppression (hence CBC), GI ulceration, and pneumonia
  • Contraindications: Pregnancy
30
Q

Biologic DMARDs

A
  • Target specific components of the inflammatory process
  • In RA, most biologic DMARDs target tumor necrosis factor
  • All pose risk of serious infection and cancer
  • Fucking expensive ($35,000 a year)
  • Frequently given in combo with methotrexate
31
Q

Etanercept

A
  • Tumor necrosis factor antagonist
  • MOA: Suppresses inflammation by inactivating TNF
  • Treats moderate to severe RA symptoms
  • Given if methotrexate doesn’t relieve symptoms
  • Mild adverse effects: Injection site reactions, headaches, rhinitis, cough, abdominal pain
  • Can cause serious infections and heart failure
  • Allergic reactions: Stevens-Johnson syndrome
32
Q

Adalimumab, certolizumab, golimumab

A

-Tumor necrosis factor antagonist for rheumatoid arthritis

33
Q

Colchecine

A
  • Gout specific NSAID
  • Side effects: Myelosuppression (decrease in bone marrow activity), rhabdomyolosis when used with statins
  • Nursing considerations: Caution when used in renal/liver/GI patients
34
Q

Allopurinol (Zyloprim)

A
  • Urate lowering agent
  • Xanthine oxidase inhibitor
  • Outcomes: Decreased uric acid level, prevention of tophi, decrease in size of existing tophi
35
Q

Probenecid

A
  • Uricosuric
  • Acts on renal tubules to inhibit reabsorption of uric acid
  • Prevents tophi and causes regression of existing tophi
36
Q

Pegloticase (Krystexxa)

A
  • Uricosuric
  • IV therapy for patients who do not respond to allopurinol (zyloprim) or probenecid
  • Enzymatic conversion of uric acid to an inactive, water soluble product
  • Nursing considerations: High risk of anaphylaxis and transfusion reactions
37
Q

Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva)

A
  • Bisphosphonate
  • MOA: Structural analogs of pyrophosphate. Pyrophosphate decreases bone resorption by inhibiting osteoclast activity
  • Outcomes: Increased bone density and reduced fracture risk
  • Taken PO on an empty stomach (30-60 minutes before eating) and patient must remain upright for 30-60 minutes to reduce the risk of esophagitis
  • Side effects: Esophagitis (ulceration), musculoskeletal pain (rare)
38
Q

Calcitonin

A
  • Osteoclast inhibitor
  • MOA: Inhibits osteoclast activity and inhibits tubular resorption and increases tubular resorption/kidney excretion of calcium (maintains normal blood calcium levels)
  • Uses: No used for prevention (hence the calcium excretion because osteoclasts are already doing bad things). 2nd line therapy to bisphonates, which are more effective
  • Administration: Intranasal (only for post-menopausal osteoporosis), parenteral (IM or SC)
  • Adverse effects: Parenteral: Nausea, vomiting, inflammation at injection site. Intra-nasal: Nasal dryness
39
Q

Estrogen

A
  • Hormone therapy
  • Suppresses osteoclast proliferation
  • Approved for post-menopausal women
  • Adverse effects: High risk of breast cancer, MI, and stroke (only use when benefits outweigh the risks)
40
Q

Raloxifene (Evista)

A
  • Selective estrogen receptor modulator (SERM)
  • MOA: Structurally similar to estrogen, meaning it binds to estrogen receptors
  • Adverse effects: No risk of breast cancer, but block box warning for DVT, PE, and stroke
  • Contraindications: Pregnancy (fetal harm)
  • Preferred over estrogen
41
Q

Denosumab

A

-Human monoclonal antibody RANKL inhibitor

42
Q

Forteo

A

-Teriperitide Injection

Pharmacology (11 decks)

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